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  #1  
Old 01-16-2017, 04:58 PM
confused66's Avatar
confused66 confused66 is offline
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Join Date: Jan 2017
Posts: 6
Default Hello Everyone! Thank you! Advice Please!

Hello to All,

First, I want to thank Harrison (and perhaps many others) for creating this online support community! I would also like to thank everyone who has taken the time to contribute their story, knowledge, advice, questions, outcomes and challenges. I have been reading and breathing information from this site over the past month. This has been an overwhelming and confusing process, and I want you to know you have already helped me immensely.

My journey of pain began over four years ago when one morning I was leaving for the gym and I bent over to put my phone in my bag (but did not bend my knees!) and simultaneously raised my head up and to left to talk to my husband. As I did this, I felt something "happen" in my back and I was stuck in that position.

Since that time, I tried a number of conservative measures including Medrol dose pack to start, ibuprofen, acetomenophin, Tramadol, physical therapy three times (land and water), a lengthy back strengthening program, icing, tens unit (love newer Aleve unit by the way), chiropractor (including massage, decompression machine, deep laser), accupuncture, supplements (circuamin, beet root powder),
three sets of selective nerve root blocks at L5-S1 and L5-S2 on the right and more recently radiofrequency ablation at L3-L5 bilaterally.

The only treatment that has helped with the pain was the first epidural steroid injection on 5-1-13 of L5-S1 and S1-S2. This took away the stabbing right hip pain and right leg pain forever. I continued to have back pain relief but only for 5 weeks. Further steroid injections in 2013 and 2014 were of no help. The icing, tens unit and Tramadol are of the only help now, but either distract me or just take the edge off while using them.

This summer I had two weeks of complete bliss after having two sets of bilateral medial branch blocks of the facet joints done at L3-L5. I was so unbelievably happy! It felt so good to be pain free! It was not to last. In between the sets of medial blocks I had bilateral steroid injections in my SI joints which helped my SI but I still had back pain. I had the L3-L5 RFA to my facet joints on the right side on 7-11-16 and then the left on 7-21-16. Sadly, this was of little benefit. I thought my facet joints would be my answer.

The pain managment physician thought the pain relief I got from the branch blocks was due to the anesthetic migrating to my disc area from area he injected above the medial nerves of the six facet joints. Whereas the laser was directly applied to the nerve and was not able to help pain in the discs. Makes sense. What do you think? Has anyone had this experience?

I did consult Anthony Yeung at Desert Institute for Spine Care (DISC) online which was not a smooth process by they way. He stated that the pain is likely coming from the L5-S1 level and that the central annular tear at L4-L5 could be contributing to some of my pain. Okay...I knew that. He recommended a right sided steroid injection of L5-S1 and bilateral medial branch blocks at L5-S1. If these procedures provided relief, he would consider a foraminal decompression and discectomy at L5-S1 with a rhizotomy from L5-S1. I have already had both of these procedures and they did not benefit due to my centralized back pain and lack of radicular symptoms. Also, my discs have degenerated over these four years and I don't want to cause further structural changes to my facet joints or other structures in my back. I want to not only remove the pain generator but also provide appropriate disc height and space. So I begin looking into ADR.

I recently consulted with a third orthopedic surgeon who agreed with me and thinks I am a candidate for ADR and feels L5-S1 is the pain generator, but unsure about L4-L5. He feels the decompression/microdiscectomy would not be of benefit to me, even with his direct visualization and thermal annuloplasty (similar to unproven IDET procedure). He does not feel I have much facet joint involvement given his MRI and physical assessment including no pain bending backward but significant pain bending even slightly forward.

I will soon receive a discoblock to L5-S1. I understand this is a positive discography. They inject an anesthetic vs. a dye and see if you have pain relief over the next 4-5 hours until the anesthetic wears off. He does not like the idea of discography due to proven injury to the control disc when injecting the needle with subsequent disc changes. I am okay with having discography by surgeon right before surgery if needed though to be certain about which disc(s) are needing replacement.

I was told by Dr. Yeung's PA (who I disagreed with on several counts) felt the discoblock was not a good way to determine pain generating disc because injecting the anesthetic would cause pressure and pain and once this is relieved, the anesthetic would wear off. She has no experience with these by the way. I am not sure if less anesthetic is injected vs the dye for the discogram or how long it would take to feel relief. Also, if I have some pain relief but not complete relief, would I do a second discoblock at L5-S1 and L4-L5? These questions came to mind after leaving doctor as usual in my case!

So I am wondering if any of you have had discoblock over discography? I found a great study finding that pain relief after injection of s small amount of bupivacaine into the painful disc was a useful tool for the diagnosis of discogenic low back pain when compared with discography. You can find this reference by typing using discoblock for diagnosis in Google and follow www.ncbi.nlm.nih.gov. published medical journal article that is listed first.
Ohtori S, et al. Spine. 2009 June 1;34(13)1345-8. Results of Surgery for Discogenic Low Back Pain: A randomized studey using discography versus discoblock for diagnosis.

After reviewing numerous posts here I have decided to pursue the help of Dr. Clavel. I have his assistant information. I am wondering if there is a chart with peoples names, surgeon, disc, outcomes from this group? I am really interested in hearing from people who have had lumbar discs replaced replaced by Dr.Clavel. It seems he does more cervical disc replacements?

I am very concerned that the appropriate disc pain generators are removed (only L5-S1 or L4-L5 also?) and the effects of removing that additional disc or not removing it.

I am so tired of living in pain. I had no idea that pain that started on 11-14-12 would become chronic. I kept having hope that some conservative measure would help only to be let down each time. I have been battling depression over this time and have sought counseling. The depression is so very tied to my levels of pain and the loss of things I used to be able to do without pain. I have a dream to one day walk my dog without pain. That would be my happy day!

I would appreciate any comments or suggestions from all of my comrades in pain and from those lucky enough to have gotten rid of it! I can only imagine the joy.

I apologize for those of you reading this long post!

Thank you!
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Hurt back 11-14-12 at home, life of pain since
1-30-13 MRI; DDD Dx. L5-S1:mod DD, mod disc space narrowing, mild stenosis & facet degen. right
L4-L5:mild DD with dorsal annular fissure & protrusion.
2-17-16 MRI; more loss of disc height at L4-L5 & L5-S1& degen endplate changes, broad post. osteophyte
L5-S1 & mild facet degen L4-L5
5-01-13/9-24-13/4-24-14: SNRB L5-S1 & S1-S2 right
6-13-16 & 7-21-16; medial branch block L3-L5
8-27-16 & 9-24-16: RFA L3-L5; RFA L3-L5 - failed
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  #2  
Old 01-18-2017, 09:57 PM
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Harrison Harrison is offline
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Join Date: Oct 2004
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Hey 66! Welcome, but I am sorry you are here. Hey, what anti-inflammatories seem to be the most effective? What are your pain levels?
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
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